This form may be used to submit a claim to the personal representative of a decedent’s or ward’s estate. The claim may be either presented directly to the personal representative or filed with the court.
The attorney should not execute the affidavit unless he has personal knowledge of the facts asserted. See section 19.17:3 in this manual regarding attorneys executing affidavits.
No. [cause number]
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In re Estate of |
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[Name of debtor], |
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[Court designation] |
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[Deceased/Ward] |
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Authenticated Claim of [name of creditor]
[Name of creditor], Claimant, presents this claim to the [executor/administrator/guardian] of the estate of [name of debtor], [Deceased/Ward].
1.Basis for Claim. This claim is based on [state facts on which claim is based].
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Include the following if the claim is supported by a document such as a note. |
A true and correct copy of the [supporting document] evidencing this claim is attached as Exhibit [exhibit number/letter] and incorporated by reference.
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Continue with the following. |
2.Amount of Claim. The amount of the claim is $[amount].
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Include the following if the claim bears interest. |
3.Interest. The claim bears interest at the rate of [percent] percent per year from [date].
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Include the following if the contract provides for attorney’s fees. |
4.Attorney’s Fees. The contract provides for recovery of attorney’s fees if the account is placed with an attorney for collection. Reasonable attorney’s fees for preparing, presenting, and collecting this claim are $[amount].
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Include the following if the claim is secured by a written security agreement or other document. |
5.Security. The claim is secured by a [describe lien instrument], granting [name of creditor] a security interest in [describe collateral]. A copy of the security agreement is attached as Exhibit [exhibit number/letter] and incorporated by reference.
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Select one of the following if the claim is a secured claim. |
6.Matured Secured Claim. Claimant elects to have the claim allowed and approved as a matured secured claim to be paid in the course of administration.
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Or |
6.Preferred Debt and Lien. Claimant elects to have the claim allowed, approved, and fixed as a preferred debt and lien against the property described above, to be paid according to the terms of the security agreement.
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Continue with the following. |
[Name]
Attorney for Claimant
State Bar No.:
[E-mail address]
[Address]
[Telephone]
[Telecopier]
Affidavit
BEFORE ME, the undersigned authority, on this day personally appeared [name of affiant], who swore on oath that the following facts are true:
“1.My full name is [name of affiant].
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Select one of the following. Select the first option if the creditor is an individual. Select the second option if the creditor is a corporation or other entity. |
“2.I am the owner of the claim described above.
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Or |
“2. I am [representative capacity] of [name of creditor]. I have made diligent inquiry and examination, and [name of creditor] is the owner of the claim.
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Continue with the following. |
“3.The claim described above is just, and all lawful offsets, payments, and credits known to me have been allowed.”
[Name of affiant]
Affiant
SIGNED under oath before me on ___________________________________.
Notary Public, State of Texas
Memorandum of Allowance
This claim was presented to me on ________________________. I have examined it, and I ALLOW it in full according to the terms of the claim.
Date of allowance: __________________________.
[Name of personal representative]
[Title of personal representative]
Order
This claim was presented and allowed by the personal representative, entered on the claims docket for at least ten days, and examined by the Court. The Court is satisfied that the claim is just and therefore APPROVES the claim according to its terms.
SIGNED on ________________________________.
JUDGE PRESIDING
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Attach exhibit(s). |